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Table of Contents
Vol. 34, No. 2, 2010
Issue release date: February 2010
Section title: Original Paper
Free Access
Neuroepidemiology 2010;34:123–129

Geographic Variation in One-Year Recurrent Ischemic Stroke Rates for Elderly Medicare Beneficiaries in the USA

Allen N.B.a, f · Holford T.R.b · Bracken M.B.c · Goldstein L.B.d · Howard G.e · Wang Y.a · Lichtman J.H.a
Divisions of aChronic Disease Epidemiology and bBiostatistics, Department of Epidemiology and Public Health, and cCenter for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn., dDepartment of Medicine (Neurology), Duke Stroke Center, Center for Clinical Health Policy Research, Duke University and Durham VAMC, Durham, N.C., eDepartment of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Ala., and fDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill., USA
email Corresponding Author

Judith Lichtman

Yale University School of Medicine

PO Box 208034

New Haven, CT 06520-8034 (USA)

Tel. +1 203 785 3025, Fax +1 203 785 6980, E-Mail


  1. Lloyd-Jones D, Adams R, Carnethon M, et al: Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:480–486.
  2. Samsa GP, Bian J, Lipscomb J, et al: Epidemiology of recurrent cerebral infarction: a Medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost. Stroke 1999;30:338–349.
  3. Pickle LW, Mungiole M, Gillum RF: Geographic variation in stroke mortality in Blacks and Whites in the United States. Stroke1997;28:1639–1647.
  4. Lanska DJ, Kryscio R: Geographic distribution of hospitalization rates, case fatality, and mortality from stroke in the United States. Neurology 1994;44:1541–1550.
  5. El-Saed A, Kuller LH, Newman AB, et al: Geographic variations in stroke incidence and mortality among older populations in four US communities. Stroke 2006;37:1975–1979.
  6. Casper M, Nwaise I, Croft J, et al: Atlas of Stroke Hospitalizations among Medicare Beneficiaries. Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.
  7. Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.
  8. Coull AJ, Rothwell PM: Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition. Stroke 2004;35:1925–1929.
  9. Sarti C, Stegmayr B, Tolonen H, et al: Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? Results from the WHO MONICA Project. Stroke 2003;34:1833–1840.
  10. Bonita R, Anderson CS, Broad JB, et al: Stroke incidence and case fatality in Australasia: a comparison of the Auckland and Perth population-based stroke registers. Stroke 1994;25:552–557.
  11. Hill ME, Rosenwaike I: The Social Security Administration’s Death Master File: the completeness of death reporting at older ages. Soc Secur Bull2001;64:45–51.
    External Resources
  12. Besag J, York J, Mollie A: Bayesian image restoration, with two applications in spatial statistics. Ann Inst Stat Math 1991;43:1–59.
    External Resources
  13. Lunn D, Thomas A, Best N, Spiegelhalter D: WinBUGS – a Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000;10:325–337.
    External Resources
  14. Petty GW, Brown RD Jr, Whisnant JP, et al: Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology 1998;50:208–216.
  15. Sacco RL, Shi T, Zamanillo MC, et al: Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994;44:626–634.
  16. Eriksson SE, Olsson JE: Survival and recurrent strokes in patients with different subtypes of stroke: a fourteen-year follow-up study. Cerebrovasc Dis 2001;12:171–180.
  17. Lisabeth LD, Smith MA, Brown DL, et al: Ethnic differences in stroke recurrence. Ann Neurol 2006;60:469–475.
  18. Matsumoto N, Whisnant JP, Kurland LT, et al: Natural history of stroke in Rochester, Minnesota, 1955 through 1969: an extension of a previous study, 1945 through 1954. Stroke 1973;4:20–29.
  19. Sacco RL, Wolf PA, Kannel WB, et al: Survival and recurrence following stroke. The Framingham Study. Stroke1982;13:290–295.
  20. Ostchega Y, Dillon CF, Hughes JP, et al: Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc 2007;55:1056–1065.
  21. Moroney JT, Bagiella E, Paik MC, et al: Risk factors for early recurrence after ischemic stroke: the role of stroke syndrome and subtype. Stroke 1998;29:2118–2124.
  22. Hillen T, Coshall C, Tilling K, et al: Cause of stroke recurrence is multifactorial: patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke 2003;34:1457–1463.
  23. Ruland S, Richardson D, Hung E, et al: Predictors of recurrent stroke in African Americans. Neurology 2006;67:567–571.
  24. Gillum RF, Ingram DD: Relation between residence in the southeast region of the United States and stroke incidence. The NHANES I Epidemiologic Follow-Up Study. Am J Epidemiol 1996;144:665–673.
  25. Howard G: Why do we have a stroke belt in the southeastern United States? A review of unlikely and uninvestigated potential causes. Am J Med Sci 1999;317:160–167.
  26. Perry HM, Roccella EJ: Conference report on stroke mortality in the southeastern United States. Hypertension 1998;31:1206–1215.
  27. Howard G, Prineas R, Moy C, et al: Racial and geographic differences in awareness, treatment, and control of hypertension: the Reasons for Geographic and Racial Differences in Stroke Study. Stroke 2006;37:1171–1178.
  28. Voeks JH, McClure LA, Go RC, et al: Regional differences in diabetes as a possible contributor to the geographic disparity in stroke mortality: the Reasons for Geographic and Racial Differences in Stroke Study. Stroke 2008;39:1675–1680.
  29. Cushman M, Cantrell RA, McClure LA, et al: Estimated 10-year stroke risk by region and race in the United States: geographic and racial differences in stroke risk. Ann Neurol 2008;64:507–513.
  30. Tirschwell DL, Longstreth WT Jr: Validating administrative data in stroke research. Stroke 2002;33:2465–2470.
  31. Leibson CL, Naessens JM, Brown RD, et al: Accuracy of hospital discharge abstracts for identifying stroke. Stroke 1994;25:2348–2355.
  32. Fisher ES, Whaley FS, Krushat WM, et al: The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain. Am J Public Health 1992;82:243–248.
  33. Benesch C, Witter DM Jr, Wilder AL, et al: Inaccuracy of the International Classification of Diseases (ICD-9-CM) in identifying the diagnosis of ischemic cerebrovascular disease. Neurology 1997;49:660–664.
  34. Kiyota Y, Schneeweiss S, Glynn RJ, et al: Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J 2004;148:99–104.
  35. Quan H, Li B, Saunders LD, et al: Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. Health Serv Res 2008;43:1424–1441.
  36. Williams GR: Incidence and characteristics of total stroke in the United States. BMC Neurol 2001;1:2.